Claims Examiner

2 weeks ago


Garden City, United States Synectics Full time

Responsibilities :

  • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Pay and process claims within designated authority level.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Confer with legal counsel on claims requiring litigation.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
Qualifications
  • Bachelor's Degree.
  • Need to be computer savvy - working with different applications, work between different applications; comfortable with a busy environment, can hit the ground running.
  • Licensing requirements vary by state: Active New York state adjuster's license required; multiple state licenses encouraged.
  • Proficiency in analytical, document management, and database query software.
  • Proficiency in Microsoft Office applications.
  • Two to four years of work related experience.
  • Exceptional attention to detail.
  • Excellent customer service and communication skills.
  • General knowledge of state and national laws and regulations.
  • General understanding of medical and legal terms.
  • Experience in a claims production environment with set goals and quality scores that must be obtained.

Benefits:

Healthcare Insurance: Synectics offers eligible employees and their dependents healthcare coverage through BlueCross BlueShield of Illinois. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics. Premiums are subsidized by Synectics.

Dental Insurance: Synectics offers eligible employees and their dependents a dental plan through MetLife. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.

Vision Insurance : Synectics offers eligible employees vision insurance through VSP. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.401(k) Plan: The Synectics Inc. Investment Savings Retirement Plan. Synectics offers all employees who are 21 years of age or older the opportunity to invest in the 401(k) Plan on the first enrollment date that is at least 30 days after employment begins. Enrollment dates are each January 1st, April 1st, July 1st, and October 1st.

Technical Certification Bonus: Synectics is pleased to award its employees a bonus of up to $500 for an approved professional certification. In determining the bonus amount, Synectics will consider the cost of the test(s) for any certification relating to your current position, achieved during your employment with us. Only one Certification Bonus per calendar year may be awarded per employee. Only current, active employees will be eligible to receive this bonus. It will be awarded 90 days after the Synectics office has received documentation confirming the successful completion of the certification.

Synectics is an equal opportunity employer.
  • Claims Examiner

    2 weeks ago


    Garden City, United States Addition Management Full time

    Position: Claims ExaminerLocation: New York, NY (hybrid)Compensation: $24-$27hr + OTFast growing insurance company seeks a Claims Examiner to join their Team!Responsibilities:Understand and appropriately apply department processes and regulatory policies.Manage new, continuous and/or periodic claims, by continually reviewing and prioritizing incoming mail...

  • Claims Examiner

    2 weeks ago


    Garden City, United States Addition Management Full time

    Position: Claims ExaminerLocation: New York, NY (hybrid)Compensation: $24-$27hr + OTFast growing insurance company seeks a Claims Examiner to join their Team!Responsibilities:Understand and appropriately apply department processes and regulatory policies.Manage new, continuous and/or periodic claims, by continually reviewing and prioritizing incoming mail...

  • Claims Examiner

    1 month ago


    Garden City, United States Collabera Full time

    Job DescriptionJob DescriptionPosition Details:Industry: InsuranceTitle: Claims ExaminerLocation: 100 % RemotePay Range :$18.00/hr - $20.00/hrResponsibilities:Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.Adjust reserves or...

  • Claim Examiner

    3 weeks ago


    Garden City, United States JobRialto Full time

    Description: Claims processing experience required Responsibilities: Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with...

  • Claim Examiner

    3 weeks ago


    Garden City, United States BCforward Full time

    Claim Examiner - US BCForward is currently looking for Claim Examiner in Garden City, NY 11530Job Title: Claim ExaminerWork Location: Garden City, NY 11530Expected Duration: 6+ Months Estimated Start Date: 08/26/2024Pay Rate: $20/hr on W2Responsibilities: * Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to...

  • Claims Examiner

    1 month ago


    California City, United States BCforward Full time

    Claims Examiner - Workers Compensation BCForward is looking for Claims Examiner - Workers Compensation in California (Remote)Position Title: Claims Examiner - Workers CompensationLocation: California (Remote)Expected Duration: 3 monthsPay Range: $45.00/hr on W2Must Have skills: Workers Compensation Claims Examiner (3+ years of California WC experience) and...


  • Any city, United States Gainwell Technologies LLC Full time

    Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career...


  • Universal City, United States Optum Full time

    WellMed is part of OptumCare, a division under the greater UnitedHealthcare Group umbrella. We have a network of doctors, specialists and other medical professionals that specialize in providing the highest level of medical care for more than 1 million older adults with over 16,000 doctors’ offices in Texas and Florida.  We’re growing, and we are...


  • Universal City, United States Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...


  • Garden City, New York, United States Collabera Full time

    Job OverviewPosition Summary:Industry: InsuranceTitle: Insurance Claims SpecialistLocation: 100% RemoteCompensation: $18.00/hr - $20.00/hrKey Responsibilities:Conduct thorough investigations, assessments, and resolutions of claims, utilizing both technical expertise and interpersonal skills to ensure fair and timely case management while contributing to a...


  • Jersey City, New Jersey, United States Arch Capital Group Full time

    About the RoleWe are seeking a highly skilled Senior Claims Examiner to join our Excess Casualty Team at Arch Capital Group. As a key member of our Claims Division, you will be responsible for actively handling and managing an Excess casualty caseload.Key ResponsibilitiesIdentify and assess coverage issues, draft coverage position letters, and retain...


  • Oklahoma City, Oklahoma, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...

  • Claims Examiner

    3 weeks ago


    Florida City, United States Synectics Full time

    Description : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of...


  • Jefferson City, Missouri, United States MO AUTO DEALERS ASSOC. Full time

    About the Role:We are seeking a highly skilled Workers Compensation Claims Specialist to join our team at MO AUTO DEALERS ASSOC. as a Workers Compensation Adjuster or General Office/Claims Assistant.Responsibilities:Manage all aspects of claim management, including claim investigation, recorded statements, compensability determination, reserve management,...


  • Any city, United States Gainwell Technologies LLC Full time

    Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career...

  • Financial Examiner

    1 month ago


    Johnson City, United States State of Kansas Full time

    Employment Benefits Comprehensive medical, mental, dental, vision, and additional coverage Sick & Vacation leave Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave Paid State Holidays (designated by the Governor annually) Fitness Centers in select locations Employee discounts with the Retirement...


  • South Sioux City, Nebraska, United States Great West Casualty Company Full time

    About the Role:This position offers the option of a hybrid work schedule based out of our office with three days in the office and two days working remotely. As a key member of our team at Great West Casualty Company, you will have the opportunity to make a meaningful impact in the lives of our policyholders.Key Responsibilities:Process and investigate...

  • Claims Examiner

    3 weeks ago


    California City, United States Techlink Systems Full time $48

    Job DescriptionJob DescriptionLocation: Brea, CA (REMOTE)Benefits: Medical Insurance, Dental Insurance, Vision Insurance, 401K REQUIREMENTS:Prior 4850 experience along with min 2 years of CA claims workers comp handling experience is required.SIP is mandatoryBachelor's degree from an accredited college or university preferred.Professional certification...


  • Kansas City, Missouri, United States Arch Capital Group Ltd. Full time

    Job SummaryWe are seeking a highly skilled Claims Adjuster - Liability Specialist to join our team at Arch Capital Group Ltd. as a Senior Claims Examiner - Liability. This role will be responsible for investigating and resolving liability claims in a fair and timely manner.Key ResponsibilitiesInvestigate and analyze liability claims to determine the extent...


  • Sun City, Arizona, United States Cincinnati Insurance Company, Inc. Full time

    Join a rewarding career in the insurance sectorIf you are eager to foster meaningful connections, work collaboratively within a diverse team, tackle challenges, and enhance your professional abilities, Cincinnati Insurance Company, Inc. could be the ideal environment for you. We provide career paths where your contributions are valued and your growth is...